Thursday, April 04, 2013

California PTs Rally Against Senate Bill 381

California
physical therapists (PTs) are preparing for a key hearing and possible vote on
legislation aimed at prohibiting them from performing joint manipulation.
California Senate Bill 381 (SB 381),
authored by state Sen Leland Yee and
sponsored by the California Chiropractic Association, is scheduled to be heard on Monday, April 15, at 1:00 pm, in the California Senate Business,
Professions, and Economic Development Committee in Sacramento.

The
legislation would prohibit anyone other than a chiropractor, physician, or
osteopath from performing joint manipulation in the state and make the term
"joint manipulation" synonymous with "joint adjustment."
Under SB 381, any health care practitioner other than a chiropractor,
physician, or osteopath who performs a joint
manipulation in California would be considered to be engaged in the unlawful
practice of chiropractic and result in the possible revocation or suspension of
the health care practitioner's license.

The legislation has been introduced under the guise of "public
protection," despite that fact that there is no data or evidence suggesting that
there is a greater threat to patient safety from physical therapists performing
joint manipulation techniques. The performance of joint manipulation by
physical therapists is different from a joint adjustment performed by
chiropractors. The legislation is part of an ongoing turf battle against
qualified physical therapists who perform joint manipulation.

APTA and its California Chapter strongly oppose SB 381, as treatment
interventions do not fall under the exclusive domain of any one specific
profession. Physical therapists, chiropractors, medical doctors, and
osteopathic physicians are all educated and trained to employ joint
manipulation within the scope of their respective licenses and in a manner that
protects the public's health, safety, and welfare. Unnecessarily restricting
any qualified licensed health care providers whose education and scope of
practice includes joint manipulation from being able to provide joint
manipulation is anti-competitive, and would diminish patient choice and
increase health care costs.

California Chapter members are encouraged to contact their state legislator and the members of the Senate Business,
Professions, and Economic Development Committee to
oppose SB 381 and, if possible, attend the April 15 hearing at the state
capitol in Sacramento.

Meanwhile,
the chapter has a number of other contentious legislative battles looming this
year: legislation to provide for full patient access (Assembly Bill 1000) was
recently introduced in the California
Assembly, while legislation to repeal its current anti-POPTS law (Assembly Bill
1003) also has been introduced.

Yee must have gotten a large monetary incentive from the Chiropractic Association. Otherwise, why would he care?

Posted by carol
on 4/5/2013 12:54 PM

These chiropractic "professionals" should be ashamed of themselves for presenting such nonsense. Their state board should hold them accountable for claiming professional superiority and degrading another profession.

Posted by Burton Ford
on 4/5/2013 2:51 PM

Gotta love the chiropractic profession! Too bad they don't have the same sense of urgency to "solve" false claims of providing physical therapy (without a PT on staff), proving that "manipulation" of infants has any medical justification....I could go on and on.

Posted by Greg Given
on 4/5/2013 3:50 PM

PT's have extensive training and knowledge of body mechanics. Many are better than medical doctors because they spend more time with you, and work within your physical limits to improve.

Posted by Joan Nygren
on 4/5/2013 5:40 PM

California SB 381 should be debated on the real merit of patient safety or harm not "turf war" lodged by the chiropractic profession for many years now. PTs are educated and skilled to perform manipulation. One of their own, Scott Haldeman, DC, MD once aptly commented "determing which professions will be allowed to practie manipulation in the future will depend in the scientific knowledge and the clinical skills of its practitioner." I believe APTA should do a national PR campaign so set the record straight.

Posted by Jesse Resari, PT, DPT, OCS
on 4/5/2013 6:54 PM

Provide me with a cirriculum that adequately trains PTs to adjust the spine. Safety may only be a small part of it. The art that comes with EXTENSIVE applied training under careful supervision is where I see PTs lack. Having practiced 30 years as a DC,the approach that your profession appears to take is one of just another modality. There is so much more. Knowing where and when to adjust, takes years to become truly proficient. Having looked at a number of PT cirriculums, I have seen nothing to support your wishes that PTs should be adjusting the spine. The choice and style of research displays a certain lack of specificity in techniques investigated, that Fritz and others publish.
The critical statement in Haldeman's statement is "clinical skills"...which are NOT provided in your education. The "skills" take hundreds of hours, minimum, people.
The irony is that not too long ago, most PTs were dissing chiropractic as unscientific, now you want to OWN it!

Posted by Bob Chatfield DC
on 4/6/2013 1:17 PM

Local chiropractor here in Texas did weekly spinal manipulations on a child for an entire year from age 1 to age 2. Insurance company required them to have evaluation in outpatient pediatric PT in order to continue paying for chiropractor after the first year. We evaluated this infant and determine that they had a typically-developing posture & movement system, no asymmetries imposture, no concerns for anything wrong. The parents had no concerns except that yhe chiro had told them they needed to come back for more joint manipulation. The only prognosis for this child was that they were at risk for secondary impairments due to joint laxity caused by the chiropractor over the past year.
My sister in law, a PT gets people better in six months whereas before they came to her hey had received 20 years worth of a chiropractor's "intervention" to no avail.
The more I hear the more I believe the APTA should be sponsoring a bill prohibiting chiropractors from practicing joint mobilizations unless under the direction of a physical therapist. Who else will protect society from chiropractors?

Posted by Ehren Howard, PT, DPT, C/NDT
on 4/6/2013 2:02 PM

First CA, then which other state!
This non substantiated,very detrimental to our profession nonsense must be nip in the bud!
Are we really talking about patient's safety here or monopoly of practice.
NO to SB 381
Marie McAndrew PT

Posted by Marie McAndrew
on 4/6/2013 4:13 PM

Bob Chatfield, DC
PT's are not trying to be artistic with manipulation. PT's are not trying to own manipulation. We're trying to be scientific and use manipulation when it's indicated and have the right to offer it to the patient. There's a difference between providing manipulation and chiropractic. They're not one in the same and PT has no interest in claiming to provide chiropractic. There isn't justification in spending thousands of hours in "training" someone in manipulation IMO, training in a handful of techniques to use appropriately and spending other time on different things makes more sense. If one wants to spend thousands of hours chasing the greatness of manipulation for everything under the sun, fine go for it, but projecting that onto another profession for the sake of artisticness is not appropriate. How often do people get manipulation from chiropractors when they present with c/o LBP? How about from physical therapists? My bet would be about 95% + from chiros and about 10-20% from PT's. Categorization/subgrouping of patient's with LBP places one in a manipulation group about 20% of the time. The majority fall into a group of repeated motion or directional preference exercise. To me, far more time should be spent on exercise interventional training for practitioners who see patient's for LBP NMSK complaints amenable to conservative care, and only 20% on manipulation/mobilization.

Posted by Burton Ford
on 4/6/2013 9:17 PM

Bod Chatfield, DC please let me correct your misguided assertions. First, we don't "adjust" because we are not chiropractors, so you can have that term. Secondly, we don't want to "own" it because unlike your profession, we fully understand based on history and evidence, no one profession owns manipulation, so lets end that baseless claim right here. Thirdly, our professions differs immensely in terms of philosophy and curriculum. Manipulation is only one intervention we are taught and trained. We follow an outcome based curriculum model not based on hours and procedures. We have tons of post professional training available via CEs, residencies and fellowships to improve our psychomotor and clinical decision making skills. We don't manipulate for the sake of manipulation. We manipulate based on the history and clinical presentation of the individual patient. We don't use it to cure diseases like hearing problems or subluxation that your profession claims (that's probably why your profession is still not fully integrated in the medical field). You cited Fritz and others for publishing nonspecific techniques. Show us studies that you've published or better yet studies that shows the difference in outcome of nonspecific and specific manipulation. Bob we have the skills but your profession just don't want to admit it. I encourage you to visit www.capteonline.org for more detailed information about our education. Thanks for your comment.

Posted by Jesse Resari, PT, DPT, OCS
on 4/7/2013 9:31 PM

Physical Therapists are more than qualified to perform joint mobilizations and we use it as an accessory to treatment, not the main staple as chiropractors. Chronic "adjustments" by chiropractors cause ligament laxity as I have seen and had to correct thanks to chiropractors. This fight is about money and patient access, not "clinical skills." And with all due respect Dr. Chatfield, we don't want to "OWN it!" but simply use it as other practitioners do. I personally had a chiropractor cause a ligament sprain in my lumbar spine due to his "EXTENSIVE" training and it was a PT that identified and helped correct my chronic SI jt pain. :)

Posted by Matt Kellum, PT, DPT, MEd
on 4/8/2013 10:19 AM

The utter nonsense posted by Bob Chatfield DC is a perfect example of the mindset present in the Chiropractic lobby. They are aware that the scientific leterature does not support the majority of their interventions and so they are attempting to legislate themsleves a monopoly on "joint manipulation" to protect their turf and limit the competition. Leland Yee should be ashamed of himself for allowing the political process to be hijacked by the chiropratic lobby in such an unethical and inappropriate manner.

Posted by Daniel Shapiro -> =OUcDL
on 4/8/2013 2:13 PM

It's all about the money. PTs are rightfully drawing a line in the sand and the chiro's piece of the pie is shrinking. Chiro schools are closing, health care is starting to look out outcomes and the fact is the chiros just don't have the data to support their practice.

Posted by David Straight, PT
on 4/9/2013 11:56 PM

I know I am a little late to the party here. I am very glad to see so many therapists across our state rallying to end this nonsense bill, obviously paid for bill.
I would like to pose a question to the chiropractors who support this bill: why are physicians not included? Last I checked, they do not get "extensive training" if at all to perform manipulations or joint adjustments. The reason: you know the AMA and the physicians in California would destroy you from a political standpoint if you even remotely tried to limit what they can and cannot do.
You can't use the same argument just for therapists. We have much more training in joint mobilization and yet you single us out. If the sole reason is patient safety and that we are not adequately trained, then everyone should be banned, including MD's.
It is amazing how corrupt politics can be. From Mary Hayashi being paid off to now Senator Yee. I would hope someday we will have policians in place who are looking out for the best interest of the patient and not the group lining their campaign pockets.